Mechanisms of Action of Fruit and Vegetable Phytochemicals in Colorectal Cancer Prevention.

Colorectal cancer (CRC) is the third most common cancer worldwide and its incidence is expected to increase by almost 80% by 2030. CRC apparition is related to poor diet, mainly due to low consumption of phytochemicals present in fruits and vegetables. Hence, this paper reviews the most promising phytochemicals in the literature, presenting scientific evidence regarding potential CRC chemopreventive effects. Moreover, this paper reveals the structure and action of CRC mechanisms that these phytochemicals are involved in. The review reveals that vegetables rich in phytochemicals such as carrots and green leafy vegetables, as well as some fruits such as pineapple, citrus fruits, papaya, mango, and Cape gooseberry, that have antioxidant, anti-inflammatory, and chemopreventive properties can promote a healthy colonic environment. Fruits and vegetables in the daily diet promote antitumor mechanisms by regulating cell signaling and/or proliferation pathways. Hence, daily consumption of these plant products is recommended to reduce the risk of CRC.

Non-thermal technologies: Solution for hazardous pesticides reduction in fruits and vegetables.

Pesticide residues in the food above the maximum permissible residual limit (MRL) for safe consumption are a severe concern today. Though unit operations employed in domestic and industrial-scale processing of foods such as high-temperature decontamination and chemical washings degrade the agrochemicals and reduce toxicity, eliminating pesticides from the fresh and raw fruits and vegetables with the retainment of nutritional and organoleptic attributes demand appropriate non-thermal technologies. In this review, the potential of novel technologies like the pulsed electric field, high-pressure processing, irradiation, ozone, ultrasonication, and cold plasma for the reduction of pesticides in fruits and vegetables have been discussed in terms of their mechanism of action, playing around factors, advantages, and limitations. All the reviewed non-thermal technologies exhibited promising effects on pesticide degradation with their unique mechanism of action. Also, these techniques' potential to reduce the pesticides below MRLs and yield nontoxic metabolites in fruits and vegetables were analyzed. However, investigating the impact of the technologies on the nutritional and organoleptic quality profile of the commodities at the processing conditions causing noticeable pesticide reduction and the pathways of degradation reactions of various pesticides with each emerging technology should be studied to enhance the applicability.

Agronomic iodine biofortification of leafy vegetables grown in Vertisols, Oxisols and Alfisols.

Iodine deficiency disorders (IDD) in sub-Saharan African countries are related to low dietary I intake and generally combatted through salt iodisation. Agronomic biofortification of food crops may be an alternative approach. This study assessed the effectiveness of I biofortification of green vegetables (Brassica napus L and Amaranthus retroflexus L.) grown in tropical soils with contrasting chemistry and fertility. Application rates of 0, 5 and 10 kg ha-1 I applied to foliage or soil were assessed. Leaves were harvested fortnightly for ~ 2 months after I application before a second crop was grown to assess the availability of residual soil I. A separate experiment was used to investigate storage of I within the plants. Iodine concentration and uptake in sequential harvests showed a sharp drop within 28 days of I application in all soil types for all I application levels and methods. This rapid decline likely reflects I fixation in the soil. Iodine biofortification increased I uptake and concentration in the vegetables to a level useful for increasing dietary I intake and could be a feasible way to reduce IDD in tropical regions. However, biofortification of green vegetables which are subject to multiple harvests requires repeated I applications.

Impact of plant extracts upon human health: A review.

With the increase in evidences directly linking diet and health, several foodstuffs, such as phenolic rich fruits and vegetables, have emerged as possessing potential health benefits. Plants, given their fiber and phenolic content (and their intrinsic biological potential), have long been considered as contributing to health promotion. Therefore, the present work aimed to review the existing evidences regarding the various potential benefits of plant extracts' and plant extract-based products' consumption, with emphasis on in vivo works and epidemiological studies whenever available. Overall, the information available supports that, while there are indications of the potential benefits of plant extracts' consumption, further human-based studies are still needed to establish a true cause-effect.

Reactions to an Online Demonstration of the Effect of Increased Fruit and Vegetable Consumption on Appearance: Survey Study.

BACKGROUND: Inadequate fruit and vegetable consumption causes a considerable disease burden and premature mortality. Despite public health promotion of a healthy diet, the average consumption is still below recommended levels. Fruit and vegetable consumption influences human skin color, increasing red/yellow/orange pigment in the skin. Given that this color is deemed attractive and healthy-looking, the appearance benefit may motivate to eat more fruit and vegetables. Such appearance motivation could be particularly useful in young individuals who currently eat the least fruit and vegetables. OBJECTIVE: Our objectives were to assess how widely the impact of diet on skin color is known within the UK and to compare the strength of motivation to eat fruit and vegetables based on health and appearance benefits among different demographic groups. METHODS: Four groups of UK residents (N=200 per group) were recruited through the Prolific online platform. Groups comprised younger (aged 18-24) and older adults (aged 40-60) of low and high self-reported socioeconomic status (1-5 and 6-10 on a 10-point rating scale). Facial images simulating the skin color associated with low and high fruit and vegetable diets were shown to participants. Questionnaires were used to assess (1) background knowledge of the health and skin color effects of dietary fruit and vegetables, (2) the specific motivational impact of the skin color illustration, and (3) the relative importance of motivation to consume fruit and vegetables arising from health and skin color appearance benefits. RESULTS: We found that 61% (n=487) of all participants were unaware of the dietary-skin color association. We also found that 57% (n=457) of participants found the simple demonstration of the dietary impact on skin color positively motivating to eat more fruit and vegetables. The visual demonstration was equally motivating for participants of high and low self-reported socioeconomic status (P=.63) and different ethnic backgrounds (White N=453, Black N=182, Asian N=87, P=.22). Health benefits from a diet high in fruit and vegetables were regarded as more motivating than skin color appearance benefits. The appearance-changing benefits of a high fruit and vegetable diet (compared to the health benefits) were relatively more important for the younger participants (Mann-Whitney U=96,263, P<.001) and for women (N=489) than for men (N=310, U=83,763, P=.01). CONCLUSIONS: These findings indicate that the promotion of the skin color effects of diets high in fruit and vegetables could provide additional motivation for a healthier diet. Our study indicates the broad appeal of appearance benefits from dietary fruit and vegetable (across ethnicity and socioeconomic status) and particularly amongst young adults where an inadequate diet is most prevalent.

Diverse food in urban gardens in the promotion of food and nutrition security in Brazil: a review.

Food and nutrition security can be supported by an urban garden. The present study comprises a critical reflection on the difficulty of producing food in urban gardens in Brazil and shows the potential of food production and the obstacles to its expansion. In addition, issues related to the agroecological management of gardens are addressed and suggestions are made to improve the proposed public policies. Urban gardens are multifunctional and have social, economic and environmental impacts. They are strategically important for supporting low-income families and urban development. Through urban gardens, diverse foods and quality foods can be produced for self-consumption. This review highlights the importance of generating detailed information on urban gardens in Brazil to support policies aimed at this sector. Long-term and multidisciplinary studies are needed to evaluate the relationship between food production in urban gardens and household food and nutrition security. This approach revealed a lack of information on the amount of food produced by Brazilians in their gardens and consumed by the household. In addition, there is little information on the management of production. There is a gap relating to the impact of food produced in urban gardens and the prevalence of food and nutrition security. © 2019 Society of Chemical Industry.

Mediterranean diet: The role of long-chain ω-3 fatty acids in fish; polyphenols in fruits, vegetables, cereals, coffee, tea, cacao and wine; probiotics and vitamins in prevention of stroke, age-related cognitive decline, and Alzheimer disease.

The mechanisms of action of the dietary components of the Mediterranean diet are reviewed in prevention of cardiovascular disease, stroke, age-associated cognitive decline and Alzheimer disease. A companion article provides a comprehensive review of extra-virgin olive oil. The benefits of consumption of long-chain ω-3 fatty acids are described. Fresh fish provides eicosapentaenoic acid while α-linolenic acid is found in canola and soybean oils, purslane and nuts. These ω-3 fatty acids interact metabolically with ω-6 fatty acids mainly linoleic acid from corn oil, sunflower oil and peanut oil. Diets rich in ω-6 fatty acids inhibit the formation of healthier ω-3 fatty acids. The deleterious effects on lipid metabolism of excessive intake of carbohydrates, in particular high-fructose corn syrup and artificial sweeteners, are explained. The critical role of the ω-3 fatty acid docosahexaenoic acid in the developing and aging brain and in Alzheimer disease is addressed. Nutritional epidemiology studies, prospective population-based surveys, and clinical trials confirm the salutary effects of fish consumption on prevention of coronary artery disease, stroke and dementia. Recent recommendations on fish consumption by pregnant women and potential mercury toxicity are reviewed. The polyphenols and flavonoids of plant origin play a critical role in the Mediterranean diet, because of their antioxidant and anti-inflammatory properties of benefit in type-2 diabetes mellitus, cardiovascular disease, stroke and cancer prevention. Polyphenols from fruits and vegetables modulate tau hyperphosphorylation and beta amyloid aggregation in animal models of Alzheimer disease. From the public health viewpoint worldwide the daily consumption of fruits and vegetables has become the main tool for prevention of cardiovascular disease and stroke. We review the important dietary role of cereal grains in prevention of coronary disease and stroke. Polyphenols from grapes, wine and alcoholic beverages are discussed, in particular their effects on coagulation. The mechanisms of action of probiotics and vitamins are also included.

Carotenoids in human nutrition and health.

Carotenoids are naturally occurring pigments found in most fruits and vegetables, plants, algae, and photosynthetic bacteria. Humans cannot synthesize carotenoids and must ingest them in food or via supplementation. Carotenoids have a range of functions in human health. They primarily exert antioxidant effects, but individual carotenoids may also act through other mechanisms; for example, ß-carotene has a pro-vitamin A function, while lutein/zeaxanthin constitute macular pigment in the eye. The benefit of lutein in reducing progression of age-related macular eye disease and cataracts is strengthening; an intake recommendation would help to generate awareness in the general population to have an adequate intake of lutein rich foods. There is evidence that carotenoids, in addition to beneficial effects on eye health, also produce improvements in cognitive function and cardiovascular health, and may help to prevent some types of cancer. Despite the evidence for the health benefits of carotenoids, large population-based supplementation studies have produced mixed results for some of the carotenoids. To establish and confirm the health benefits of the different carotenoids more research, including clinical studies, is needed.

Functional Nitric Oxide Nutrition to Combat Cardiovascular Disease.

PURPOSE OF REVIEW: To reveal the mechanisms of nitric oxide (NO) production in humans and how lifestyle, drug therapy, and hygienic practices can decrease NO production. Furthermore, to show how functional nitric oxide nutrition can overcome these limitations to restore endogenous NO production and combat cardiovascular disease. RECENT FINDINGS: Research over the past decade has revealed that inorganic nitrate and nitrite found naturally in green leafy vegetables and other vegetables such as beets can provide the human body with a source of bioactive nitric oxide. NO is one of the most important molecules produced within the cardiovascular system that maintains normal blood pressure and prevents inflammation, immune dysfunction, and oxidative stress, hallmarks of cardiovascular disease. This pathway is dependent upon the amount of inorganic nitrate and nitrite in the foods we eat, the presence of oral nitrate-reducing bacteria, and sufficient stomach acid production. The concept of food being medicine and medicine being food has lost its place in the practice and implementation of modern medicine over the past century. Certain dietary patterns and specific foods are known to confer very significant protective effects for many human diseases, including cardiovascular disease, the number one killer of men and women in the developed world. However, identification of single or multiple bioactive molecules that are responsible for these effects has escaped scientists and nutritionists for many years. This review will highlight the biochemical, physiological, and epidemiological basis for functional nitric oxide nutrition that can be safely and effectively utilized in patients.

Antimony contamination, consequences and removal techniques: A review.

A significant amount of antimony (Sb) enters into the environment every year because of the wide use of Sb compounds in industry and agriculture. The exposure to Sb, either direct consumption of Sb or indirectly, may be fatal to the human health because both antimony and antimonide are toxic. Firstly, the introduction of Sb chemistry, distribution and health threats are presented in this review, which is essential to the removal techniques. Then, we provide the recent and common techniques to remove Sb, including adsorption, coagulation/flocculation, membrane separation, electrochemical methods, ion exchange and extraction. Removal techniques concentrate on the advantages, drawbacks, economical efficiency and the recent achievements of each technique. We also take an overall consideration of experimental conditions, comparison criteria, and economic aspects.

The effect of new purchase criteria on food procurement for the Brazilian school feeding program.

OBJECTIVE: To explore the effect of the school feeding program purchase criteria on the quantity, variety and origin of food products acquired for school meals in a municipality in Brazil. METHOD: Analysis of purchase lists for two years prior and two years after implementation of the purchase criteria (2010). The origin (family farms (FF)/other providers (OP)) and nutritional characteristics (recommended/controlled) of food products were studied, registering annual varieties (n) and daily quantities (kg/day); contrast of proportions was applied. RESULTS: The acquisition of recommended products increased, and the quantity of controlled products decreased (p = 0.005). Purchase of legumes and vegetables (p < 0.05) increased and high sugar foods decreased (p = 0.02). The majority of food products in 2010 and 2011 were acquired from OP (64% and 61%), although FF provided the greatest proportion of legumes and vegetables. Ten new varieties of recommended products were incorporated, 9 of which were acquired from FF. CONCLUSION: The criteria of direct purchase from family farms resulted in an increase in the variety and quantity of healthy foods in the schools in the municipality.

Reduction in Vegetable Intake Disparities With a Web-Based Nutrition Education Intervention Among Lower-Income Adults in Japan: Randomized Controlled Trial.

BACKGROUND: No existing Web-based nutrition education interventions have been evaluated in light of socioeconomic status just in Japan. OBJECTIVE: The aim was to investigate the effect of a Web-based intervention program on reducing vegetable intake disparities between low- and middle-income Japanese adults. METHODS: In this randomized controlled trial, participants were assessed at three time points-baseline, postintervention (5 weeks later), and a follow-up after 3 months-from October 2015 to March 2016. We collected data via a Japanese online research service company from 8564 adults aged 30 to 59 years. Participants were stratified according to national population statistics for gender and age, and randomly selected. They were then randomly allocated into intervention (n=900) and control (n=600) groups such that both groups contained an equal number of individuals with low and middle income. The intervention program encouraged behavior change using behavioral theories and techniques tailored to their assumed stage of change. The outcome was vegetable intake servings per day (1 serving being approximately 70 g). RESULTS: Out of 900 participants who started, 450 were from the middle income group (of which 386 or 85.7% completed the intervention), and 450 were from the low income group (of which 371 or 82.4% completed). In the intervention group, vegetable intake increased in the low-income participants from baseline to postintervention (0.42 servings, 95% CI 0.11-0.72). A two-way analysis of variance showed that low-income participants had significant main effects of group (η2=0.04, P=.01) and time (η2=0.01, P<.001), and a significant interaction (η2=0.01, P=.009). Middle-income participants also had a significant main effect of time (η2=0.01, P=.006) and a significant interaction (η2=0.01, P=.046). CONCLUSIONS: This Web-based nutritional education intervention could fill the vegetable intake gap between low- and middle-income adults in Japan, and is expected to prevent noncommunicable and lifestyle-related diseases. Further intervention program improvements are necessary to maintain and increase vegetable intake for other groups. TRIAL REGISTRATION: Current Controlled Trials (UMIN-ICDR): UMIN000019376; https://upload.umin.ac.jp/cgi-open-bin/ icdr_e/ctr_view.cgi?recptno=R000022404 (Archived by WebCite at http://www.webcitation.org/6u9wihBZU).

Bioactive Compounds in Brassicaceae Vegetables with a Role in the Prevention of Chronic Diseases.

The beneficial role of the Mediterranean diet in the prevention of chronic diseases, including cardiovascular diseases, diabetes, and obesity, is well-recognized. In this context, Brassicaceae are considered important vegetables due to several evidences of their health promoting effects that are associated to bioactive compounds present in the edible parts of the plants. In this review, the mechanisms of action and the factors regulating the levels of the bioactive compounds in Brassicaceae have been discussed. In addition, the impact of industrial and domestic processing on the amount of these compounds have been considered, in order to identify the best conditions that are able to preserve the functional properties of the Brassicaceae products before consumption. Finally, the main strategies used to increase the content of health-promoting metabolites in Brassica plants through biofortification have been analyzed.

Plant Polyphenols as Chemopreventive Agents for Lung Cancer.

Lung cancer may be prevented by a diet rich in fruits and vegetables as they are enriched with dietary antioxidant polyphenols, such as flavonoids, proanthocyanidins, lignans, stilbenes, and phenolic acids. Dietary polyphenols exert a wide range of beneficial biological functions beyond their antioxidative properties and are involved in regulation of cell survival pathways leading to anticarcinogenic and antimutagenic functions. There are sufficient evidence from in vitro, in vivo, and epidemiological studies to suggest that the dietary intervention of polyphenols in cancer prevention, including the chemopreventive ability of dietary polyphenols, act against lung carcinogens. Cohort and epidemiological studies in selected risk populations have evaluated clinical effects of polyphenols. Polyphenols have demonstrated three major actions: antioxidative activity, regulation of phase I and II enzymes, and regulation of cell survival pathways against lung carcinogenesis. They have also shown an inverse association of lung cancer occurrences among high risk populations who consumed considerable amounts of fruits and vegetables in their daily diet. In in vitro cell culture experimental models, polyphenols bind with electrophilic metabolites from carcinogens, inactivate cellular oxygen radicals, prevent membrane lipid peroxidation and DNA oxidative damage, and adduct formation. Further, polyphenols enhance the detoxifying enzymes such as the phase II enzymes, glutathione transferases and glucuronosyl transferases.

Natural Products for the Prevention and Treatment of Hangover and Alcohol Use Disorder.

Alcoholic beverages such as beer, wine and spirits are widely consumed around the world. However, alcohol and its metabolite acetaldehyde are toxic and harmful to human beings. Chronic alcohol use disorder or occasional binge drinking can cause a wide range of health problems, such as hangover, liver damage and cancer. Some natural products such as traditional herbs, fruits, and vegetables might be potential dietary supplements or medicinal products for the prevention and treatment of the problems caused by excessive alcohol consumption. The aim of this review is to provide an overview of effective natural products for the prevention and treatment of hangover and alcohol use disorder, and special emphasis is paid to the possible functional component(s) and related mechanism(s) of action.

Assessment of different washing treatments to mitigate imidacloprid and acetamaprid residues in spinach.

BACKGROUND: Agricultural crops treated with pesticides retain toxic residues that can cause various health disorders upon consumption. The present research project was designed to assess pesticide residues in contaminated spinach (Spinacia oleracea). The efficiency of chemical solutions (acetic acid, citric acid, hydrogen peroxide, sodium chloride and sodium carbonate) of different concentrations (% w/v) along with tap water for the dissolution of pesticide residues in spinach was studied. After various dipping treatments (T0 -T22 ) of treated spinach, imidacloprid and acetamaprid residues were determined by high-performance liquid chromatography (HPLC). RESULTS: Among the solutions tested, the highest reductions in imidacloprid and acetamaprid residues respectively were 0.92 ± 0.04 mg kg(-1) (83%) and 1.42 ± 0.53 mg kg(-1) (87%) in treatment T6 (10% acetic acid), followed by 0.79 ± 0.01 mg kg(-1) (69%) and 0.86 ± 0.05 mg kg(-1) (71%) in treatment T11 (10% citric acid), while the lowest were 0.30 ± 0.02 mg kg(-1) (27%) and 0.35 ± 0.02 mg kg(-1) (29%) in treatment T20 (4% sodium carbonate). Moreover, treatment T1 (tap water) caused 0.27 ± 0.00 mg kg(-1) (23%) and 0.38 ± 05 mg kg(-1) (27%) elimination of imidacloprid and acetamaprid residues respectively. CONCLUSION: From these findings it is inferred that acetic acid and citric acid washing treatments can be used along with tap water to minimize pesticide residues in treated vegetables. © 2015 Society of Chemical Industry.

Review: dietary phenolic compounds, health benefits and bioaccessibility.

Phenolic compounds are ubiquitous in plant-based foods. High dietary intake of fruits, vegetables and cereals are related to a decreased rate in chronic diseases. Phenolic compounds are thought to be responsible, at least in part, for those health effects. No-netheless, the bioaccessibility of phenolic compounds is not often considered in these studies; thus, a precise mechanism of action of phenolic compounds is not known. In this review, we aim to present a comprehensive knowledge of the potential health promotion effects of polyphenols and the importance of considering the factors that affect their bioavailability on research projects.

Status of bioactive compounds in foods, with focus on fruits and vegetables.

Components of cereals, legumes, pulses, proteins, sea food, milk, carbohydrates and lipids are being evaluated for their influence on human health, as biofunctional compounds. However, references dealing with fruits and vegetables exceed any other food group and accordingly their focus. Fruits and vegetables abound in a spectacular range of such health influencing compounds and thus, study of their bioactivity, in lieu of their consumption in fresh or processed form. Anti-cancerous phenolics from Phyllanthus, radioprotective Litchi phenolics/flavonoids, hypoglycemic Sygium, quercitin and hydroxyl cinnamates of Sweet cherries, xanthones of Mangosteen, ellagitannins of Pomegranate, ursolic acid of Sea buckthorn, muscle relaxative watermelon, anti-cholesterolemic soluble fibre and sterols, cardioprotective saponins, ACE-inhibitory potato hydrolysates, anti-pancreatic cancerous ascorbic acid, carotenoids including pro-vitamin A are few examples unraveled. Thus, the imminent scope to obviate their structural chemistry, influence on storage and processing conditions, factors favoring their bio-accessibility/bio-availability in the food formulations, influencing human health. It is the meticulous combination of these compounds in daily consumption that determines their usefulness to human body. What is of paramount importance is the actual health benefits accrued from consumption of such functional- compound based fresh/processed fruits,vegetables or other foods.

A qualitative study of shopper experiences at an urban farmers' market using the Stanford Healthy Neighborhood Discovery Tool.

OBJECTIVE: To understand factors which enhance or detract from farmers' market shopper experiences to inform targeted interventions to increase farmers' market utilization, community-building and social marketing strategies. DESIGN: A consumer-intercept study using the Stanford Healthy Neighborhood Discovery Tool to capture real-time perceptions via photographs and audio narratives. SETTING: An urban farmers' market in a large metropolitan US city. PARTICIPANTS: Thirty-eight farmers' market shoppers, who recorded 748 unique coded elements through community-based participatory research methods. RESULTS: Shoppers were primarily women (65 %), 18-35 years of age (54 %), non-Hispanic (81 %) and white (73 %). Shoppers captured 291 photographs (7·9 (sd 6·3) per shopper), 171 audio narratives (5·3 (sd 4·7) per shopper), and ninety-one linked photograph + audio narrative pairs (3·8 (sd 2·8) per shopper). A systematic content analysis of the photographs and audio narratives was conducted by eight independent coders. In total, nine common elements emerged from the data that enhanced the farmers' market experience (61·8 %), detracted from the experience (5·7 %) or were neutral (32·4 %). The most frequently noted elements were freshness/abundance of produce (23·3 %), product presentation (12·8 %), social interactions (12·4 %) and farmers' market attractions (e.g. live entertainment, dining offerings; 10·3 %). CONCLUSIONS: While produce quality (i.e. freshness/abundance) was of primary importance, other contextual factors also appeared important to the shoppers' experiences. These results may inform social marketing strategies to increase farmers' market utilization and community-building efforts that target market venues.

Assessment of exposure to soils contaminated with lead, cadmium, and arsenic near a zinc smelter, Cassiopée Study, France, 2008.

After 150 years of industrial activity, significant pollution of surface soils in private gardens and locally produced vegetables with lead, cadmium, and arsenic has recently been observed in Viviez (Southern France). A public health intervention was conducted in 2008 to identify individual health risks of Viviez inhabitants and to analyze their environmental exposure to these pollutants. Children and pregnant women in Viviez were screened for lead poisoning. Urinary cadmium testing was proposed to all inhabitants. Those with urinary cadmium levels over 1 µg/g creatinine were then tested for kidney damage. Urinary cadmium and arsenic levels were compared between participants with non-occupational exposure from Viviez and Montbazens, a nearby town not exposed to these two pollutants, in order to identify environmental factors contributing to impregnation. No case of lead poisoning was detected in Viviez, but 23 % of adults had urinary cadmium over 1 µg/g creatinine, 14 % of whom having markers of kidney damage. Viviez adults had higher levels of urinary cadmium, and to a lesser extent, higher levels of urinary arsenic than those from Montbazens. Consumption of local produce (vegetables and animals) and length of residence in Viviez were associated with higher urinary cadmium levels, independently of known confounding factors, suggesting persisting environmental exposure to contaminated soil. To conclude, health risks related to cadmium exposure were identified in the Viviez population living on contaminated soils. Lead and arsenic exposure did not pose health concerns. Interventions were proposed to reduce exposure and limit health consequences.